Active NPI
Stefane Davis, PA
- Physician Assistant
- Denver, CO
National Provider Identifier
1083740963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1013
- Practice address
- 2130 Stout St.
Denver, CO 80205-2526 - Phone
- (303) 293-2220
- Fax
- (303) 293-3977
- NPI assigned
- Feb 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1013 | CO | Primary |
Addresses
Primary practice location
2130 Stout St.
Denver, CO 80205-2526
Mailing address
2130 Stout St
Denver, CO 80205-2526
Phone (303) 293-2220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19704852 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161121002765 | CO | Order and Referring Only - Physician Assistant | 5991853467 |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 1994
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Colorado Coalition for the Homeless
Practice addresses (Care Compare)
2130 Stout St
Denver, CO 80205-2827
Phone (303) 293-2220
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1013 | CO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409788800000",
"number": "1083740963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2130 STOUT ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802052526",
"telephone_number": "303-293-2220",
"fax_number": "303-293-3977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2130 STOUT ST.",
"city": "DENVER",
"state": "CO",
"postal_code": "802052526",
"telephone_number": "303-293-2220",
"fax_number": "303-293-3977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "STEFANE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-26",
"last_updated": "2014-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "1013",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "19704852",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.